Contamination and current practice in decontamination pof nebulisers in ventilated patients

Abstract

To examine the incidence of contamination and current practice of decontamination of nebulisers after use within a ventilator circuit, in public- and private sector intensive care units (ICUs) in Johannesburg; to assess the presence of and adherence to a decontamination protocol in these ICUs and to identify which practices were associated with lower or no bacterial growth. Methods: A cross-sectional study design was used which included a semi-structured interview with the ICU manager and an audit of current nebuliser practice. Nebulisers that were identified in the interview were swabbed and streaked on blood agar plates (BAPs). BAPs were incubated and assessed for bacterial colonisation, number of colony forming units (CFUs) and number of different species of CFUs present. Results: Two hundred and sixty-nine ICU beds were surveyed over a two-month period resulting in 45 nebulisers used within a ventilator circuit that could be tested. The majority (93%) were single-use jet nebulisers, all were being re-used and 52% presented with contamination. None of the ICUs had a nebuliser decontamination protocol in place. Contaminated nebulisers that were stored in a sterile drape had significantly higher concentrations of bacterial growth (p=0.03). Conclusion: The rate of colonisation of re-used jet nebulisers is high. Nebuliser decontamination protocols are urgently needed.